What are Medication Overuse Headaches a.k.a. Rebound Headaches?

January 26, 2024
July 20, 2022
What are Medication Overuse Headaches a.k.a. Rebound Headaches?

Medication overuse headache (MOH), as the name implies, is a perpetuating cycle of having headaches and continuing to take acute medication on a frequent basis.

Often when you experience a headache, you rely on as-needed treatment for immediate relief. If headaches are not well managed, you will continue to reach for acute medications. However, if taken greater than two or three days per week on a long-term basis, this can lead to the development of "rebound headaches," which is the colloquial term for Medication Overuse Headache.

If you find yourself taking abortive treatment more days than not, it is likely you are experiencing MOH, and should seek care to discuss a more effective treatment plan.

Patients with a history of migraine, tension-type headache, cluster headache, and hemicrania continua are more inclined to develop MOH, especially if headaches are not well-controlled, resulting in a need of more acute medications. Additionally, clinical research provides evidence that there is a genetic predisposition to MOH. We see that individuals with a prior history of headache disorders are more susceptible to experiencing this form of headache. Studies looking at individuals taking daily pain relievers for other chronic conditions, such as arthritis, are not likely to trigger rebound headaches in those without a headache disorder.

Symptoms of Medication Overuse Headache

Often a headache will occur upon awakening, relieved once the acute treatment is taken, and the headache begins to return once the medication wears off. These individuals will experience greater than 15 headache days per month. In addition, there is a regular overuse of acute treatment for more than three months with one or more medications.

Causes of Medication Overuse Headache

The risk of MOH appears to be highest with opioids, nonsteroidal anti-inflammatory drugs, butalbital-containing combination agents, and acetaminophen-aspirin-caffeine combination medications. In addition, ergotamines and triptans can contribute to MOH. Clinicians will emphasize the importance of limiting abortive treatment to no more than 2-3 days per week depending on the agent.

Treatments for Medication Overuse Headache

Treatment includes stopping the overused medication. Often bridge therapy will help to break this difficult cycle. In addition, your doctor will likely discuss a plan to add on preventive treatment. It is important to keep in mind that headaches may worsen during this time of withdrawing the current medication. There will be a plan in place to continue acute treatment with certain limits.

Looking to speak with a neurologist about your headache or migraine? Consider trying Neura Health so you can schedule a video visit from the comfort of home. Our neurologists are available for same-day and next-day appointments so you can find relief fast.

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Jasmine Bhasin, PA-C
Jasmine Bhasin is a Physician Assistant specializing in headache medicine, based in the San Francisco Bay Area.
About the Author
Jasmine Bhasin is a Physician Assistant specializing in headache medicine, based in the San Francisco Bay Area. Prior to joining Neura Health, she worked in the Department of Neurology at UW (University of Wisconsin) Health where she specialized in migraine and headache disorders. Jasmine began her career in family practice and aesthetics where she adopted an interest in alternative medicine. She continues to focus patient care based on preventative medicine with a holistic approach, where treatment plans are incorporated with non-pharmacologic management such as lifestyle changes, alternative medicine, physical therapy, and supplements. She also performs botox injections, supraorbital nerve blocks, occipital nerve blocks, and trigger point injections. Jasmine completed her undergraduate degree in Human Development at UC San Diego. She went on to receive her Master of Science in Physician Assistant studies from Western University.

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